Healthcare Provider Details

I. General information

NPI: 1558398875
Provider Name (Legal Business Name): STEVEN ALAN FERGUSON MS RD LD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SPRING VALLEY DR VA MEDICAL CENTER
HUNTINGTON WV
25704
US

IV. Provider business mailing address

126M RIVERVIEW RD
FRAZIERS BOTTOM WV
25082-9405
US

V. Phone/Fax

Practice location:
  • Phone: 304-429-6755
  • Fax: 304-429-0264
Mailing address:
  • Phone: 204-937-3174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: